To gather baseline data on hand hygiene (HH) practices in an African hospital with a newly established infection prevention and control team.

Cross-sectional, observational study.

Komfo Anokye Teaching Hospital, a large teaching hospital in Ghana with approximately 1,000 beds.

All hospital staff with patient contact were eligible for assessment of HH practices.

HH observations were conducted using a standardized data collection tool and method based on the World Health Organization's “5 Moments of Hand Hygiene.” Small-group interviews were conducted to gather additional information on perceptions of HH and barriers to its use. HH resource needs were also assessed using a standardized tool.

HH was attempted in 12% of the opportunities and was performed appropriately in 4% of the opportunities. Most main wards (89%) had at least 1 functional HH station. The most commonly identified barriers to HH were limited resources and lack of knowledge on appropriate times to perform HH.

We developed and applied tools to evaluate HH resources and practices in a large African hospital. These assessments were undertaken to guide future efforts to improve HH at this hospital but can also serve as a model of the way to perform a systematic assessment at acute care hospitals in developing countries.